<!DOCTYPE html PUBLIC "-//W3C//DTD XHTML 1.0 Transitional//EN" "http://www.w3.org/TR/xhtml1/DTD/xhtml1-transitional.dtd">
<html xmlns="http://www.w3.org/1999/xhtml">
    <head>
        <meta http-equiv="Content-Type" content="text/html; charset=utf-8" />
        <link type="text/css" rel="stylesheet" href="<?php echo base_url()?>system/public/css/styles.css" />
        <script type="text/javascript" src="<?php echo base_url()?>system/public/js/jquery.ui/jquery.js"></script>
        <script type="text/javascript" src="<?php echo base_url()?>system/public/js/validation.js"></script> 
    </head>
    <body>
        <input type="hidden" id="request" value="<?php echo $this->uri->segment(3); ?>" />
        <h1 class="blue">
            Contact Us
        </h1>
        <p>&nbsp;</p>
<?php        
        $attributes = array(
            'id' => 'targets'); 
        echo form_open_multipart(base_url()."index.php/page/sendmail/", $attributes );        
?>                
            <table width="100%">
                <tr>
                    <td>&nbsp;</td>
                    <td>
                        <span class="mandatory">First name</span>
                    </td>
                    <td >
                        <input  type="text" name="first_name" class="mandatory" maxlength="50" size="30" />
                    </td>
                </tr>
                <tr>
                    <td>&nbsp;</td>
                    <td >
                        <span class="mandatory">Last name</span>
                    </td>
                    <td   align="left">
                        <input  type="text" name="last_name" class="mandatory" maxlength="50" size="30" />
                    </td>
                </tr>
                <tr>
                    <td>&nbsp;</td>
                    <td >
                        <span class="mandatory">Email</span>
                    </td>
                    <td   align="left">
                        <input  type="text" name="email" class="mandatory_email" maxlength="80" size="30" />
                    </td>
                </tr>
                <tr>
                    <td>&nbsp;</td>
                    <td >
                        Phone number
                    </td>
                    <td >
                        <input  type="text" name="telephone" maxlength="30" size="30" class="phone"/>
                    </td>
                </tr>
                <tr>
                    <td>&nbsp;</td>
                    <td style="vertical-align: top;">                                        
                        <span class="mandatory">Comments</span>
                    </td>
                    <td >
                        <textarea  name="comments" class="mandatory" maxlength="1000" cols="25" rows="6"></textarea>
                    </td>
                </tr>
                <tr>
                    <td>&nbsp;</td>
                    <td></td>
                    <td>
                        <input type="submit" value="Submit" class="search" />
                    </td>
                </tr>
            </table>
<?php 
        echo form_close();
?>         
    </body>
</html>  